Introduction and Treatment Landscape Overview

Dr. Neil Iyengar from Winship Cancer Institute introduces the program on multidisciplinary perspectives in hormone receptor-positive, HER2-negative metastatic breast cancer and triple-negative breast cancer, joined by Dr. Sara Nunnery from Tennessee Oncology, Dr. Sarah Sunshine (ophthalmologist) from University of Maryland, and Ms. Debbi-Ann Davidson (nurse manager) from Winship Cancer Institute.

The program addresses the evolving treatment landscape with emphasis on emerging clinical data and multidisciplinary care strategies influencing routine clinical practice. The discussion will review evidence from recent clinical trials evaluating antibody-drug conjugates including TROPION-Breast01, TROPION-Breast02, and ASCENT-03.

Dr. Nunnery outlines the current treatment framework for hormone receptor-positive disease, emphasizing three approved cytotoxic options with specific sequencing considerations. Trastuzumab deruxtecan (T-DXd) represents the first-line option for HER2-low or HER2-ultra-low patients progressing after endocrine therapy, offering the advantage of use before any prior chemotherapy.

Following T-DXd progression, two TROP2-targeting ADCs become available: datopotamab deruxtecan and sacituzumab govitecan, both requiring prior chemotherapy or another ADC before use. This framework prioritizes HER2 status assessment for T-DXd eligibility, followed by TROP2-targeted options in subsequent lines.

The practical treatment approach involves determining HER2-low/ultra-low status for immediate T-DXd consideration, with TROP2-targeted ADCs reserved for later-line settings after chemotherapy progression. This sequencing strategy maximizes available targeted options while considering regulatory approval parameters and optimal patient outcomes.